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Medical Center Tower I 7950 Floyd Curl Drive Suite 803 San Antonio, TX 78229 tel: 210-615-9500 fax: 210-615-9600 email: office at cecst.com |
Specializing in the compassionate care of people who suffer from abnormalities of the electrical system of the heart |
Current Insurance Plans:
We accept most major commercial insurance plans. Please call for details. Medicare: We have opted out of Medicare, and are happy to care for Medicare beneficiaries on an affordable cash basis. Note: Federal law prohibits signing the Federally-mandated opt-out contract with a Medicare beneficiary who is in an emergency situation. No insurance? No problem! Consider our affordable Fee for service (direct pay). Home of the Original Personalized Medical Office SystemTM released April 5, 2013 |
| The Arrhythmias Section Contents |
| The Ventricular Tachycardias | |
| The ventricular tachycardias (VTs) are fast heart rhythms that arise entirely within the lower chambers of the heart (the ventricles). They are faster than 100 to 120 beats per minute by definition. They make people feel bad (are important clinically) when they reach rates of more than 150 beats per minute or so. The most common type of ventricular tachycardia is the intramyocardial reentrant type of monomorphic VT that occurs in people who have had heart attacks (myocardial infarction) in the past. Less common, but not rare, are the VTs that occur in otherwise normal young people, which usually arise from one of two specific areas in the heart. Torsades de pointes is usually caused as a side effect of certain drugs (including most of the antiarrhythmic drugs). The polymorphic ventricular tachycardias are usually caused by myocardial ischemia. Ventricular fibrillation can occur by itself, often when myocardial ischemia is present, or after one of the other VTs has persisted for a long time. Sudden cardiac death is the end result of untreated rapid VT or ventricular fibrillation. | |
| The Monomorphic Ventricular Tachycardias (VT) | |
The monomorphic ventricular tachycardias are those which, on the
ECG, have the same appearance from beat to beat. That is, all
the QRS complexes on the ECG look the same except for occasional
fusion beats. In general, these rhythms should be treated
according to the Advanced Cardiac Life Support (ACLS) protocol.
Specific rhythms such as Right ventricular outflow tract VT and
Belhassen's VT may respond to adenosine, beta blockers, or
verapamil, but these agents should not be used
unless the diagnosis is certain, because they can be
fatal if they are administered to someone who is having
other types of monomorphic VT.
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| Polymorphic Ventricular Tachycardia | |
| The polymorphic ventricular tachycardias are those which, on the ECG, have the differences in appearance from beat to beat. That is, the QRS complexes on the ECG look different from each other. This rhythm includes torsades de pointes, which is a particular kind of polymorphic VT. The polymorphic VTs can arise from myocardial ischemia, myocarditis, long QT syndrome, and a variety of other causes. They are often self-terminating, but can be rapidly fatal if they persist. The treatment is prompt cardioversion if the rhythm is sustained, followed by intravenous magnesium, avoidance of agents that prolong the QT interval, and correction of myocardial ischemia, hypoxia, and electrolyte abnormalities. | |
| Torsades de Pointes | |
| Torsades de pointes is a particular kind of polymorphic VT that is characterized by onset with an early complex that follows a long pause, prior evidence of pause-dependent changes in the sinus T wave, and a sinusoidal quality to the change in QRS shape. It is seen most often in the setting of long QT syndrome due to antiarrhythmic drug toxicity or congenital cause. Episodes of this rhythm are often self-terminating, but can be rapidly fatal if they persist. The treatment is prompt cardioversion if the rhythm is sustained, followed by intravenous magnesium, avoidance of agents that prolong the QT interval, and correction of myocardial ischemia, hypoxia, and electrolyte abnormalities. | |
| Ventricular Fibrillation and Ventricular Flutter | |
| Ventricular fibrillation is a lethal, disorganized one that is synonymous with clinical death. It requires prompt defibrillation by electrical DC countershock according to the Advanced Cardiac Life Support (ACLS) protocol. People who survive an episode of ventricular fibrillation should be treated with an implantable cardioverter defibrillator, which is much more effective than any available antiarrhythmic medication. Ventricular flutter is a more organized but very rapid rhythm (by definition, greater than 250 beats per minute) that is just as lethal as ventricular fibrillation and is treated the same way. | |
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